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目的 :探讨血清胃蛋白酶原 (PG)水平变化与我国胃癌高发区居民胃癌发生的关系及PG异常在人群胃癌筛查中的价值。方法 :在对赞皇县 15 0 4名农村居民进行血清PG和HP抗体检测的基础上 ,对受检居民进行了随访 ,并分析了受检后 16～ 30个月胃粘膜病理形态学变化。结果 :赞皇县居民血清PG水平具有明显的性别差异 ,男性居民PGⅠ、PGⅡ和PGⅠ /PGⅡ比值明显高于女性居民 ,但男女居民中血清PG异常者检出率无明显差异(11.7%∶9.6 % ,P >0 .0 5 )。随访期内PG异常居民胃癌死亡率 (0 .6 4% )高于正常居民 (0 .0 0 7% ) ,但统计学意义不明显。血清PG异常组居民胃粘膜腺体萎缩和腺上皮不典型增生的发生率均达到 70 %以上 ,肠上皮化生的发生率也超过 5 0 % ,明显高于血清PG正常居民 (P <0 .0 1)。血清PG异常伴HP抗体阳性者腺体萎缩、肠上皮化生及腺上皮不典型增生发生率均明显高于HP抗体阴性者。结论 :血清PG异常居民胃粘膜多有明显的癌前病变 ,是胃癌的高危人群。
Objective: To explore the relationship between serum pepsinogen (PG) levels and the occurrence of gastric cancer in the high incidence areas of gastric cancer in China and the value of PG abnormality in the screening of gastric cancer in the population. Methods: Based on the detection of serum PG and HP antibody in 540 rural residents in Zanhuang County, the residents were followed up and the pathological changes of gastric mucosa were analyzed 16-30 months after the examination. Results: Serum PG levels in Zanhuang residents had significant gender differences. The ratios of PGI, PGII and PGI/PGII in male residents were significantly higher than female residents, but there was no significant difference in the detection rate of abnormal serum PG among male and female residents (11.7%: 9.6 %, P >0 .0 5 ). During the follow-up period, the mortality rate of abnormal gastric cancer among PG residents (0.64%) was higher than that of normal residents (0.07%), but the statistical significance was not significant. The incidence of gastric mucosal gland atrophy and glandular epithelial dysplasia in the abnormal PG abnormal group was above 70%, and the incidence of intestinal metaplasia was over 50%, which was significantly higher than that of normal PG resident population (P<0. 0 1). The incidence of glandular atrophy, intestinal metaplasia, and atypical hyperplasia of glandular epithelium in patients with abnormal serum PG and HP antibody were significantly higher than those with negative HP antibody. Conclusion: There are many precancerous lesions in gastric mucosa of abnormal PG abnormal residents, which is a high risk population of gastric cancer.